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Renal protection and angiotensin converting enzyme inhibition in microalbuminuric type I and type II diabetic patients.
J Hypertens Suppl 1996; 14(6):S11-4JH

Abstract

BACKGROUND

Many studies have emphasized the role of antihypertensive drugs and in particular angiotension converting enzyme (ACE) inhibitors in the retardation of diabetic nephropathy. Although these studies have focused predominantly on patients with overt proteinuria, more recently a number of investigators have explored the role of ACE inhibitors in both type I and type II diabetic patients with an earlier phase of diabetic renal disease known as microalbuminuria. These agents are now being considered as renoprotective agents not only in hypertensive patients but also in those with 'normal' blood pressure. Initially, studies in type I diabetic patients showed that ACE inhibition was effective in retarding the increase in albuminuria which was observed in placebo treated groups. More recently, several multi-centre placebo controlled studies have been performed suggesting that prolonged treatment not only reduced albuminuria but also preserved renal function. The role of ACE inhibition in microalbuminuric type II diabetic patients is less well characterised although several studies have recently described beneficial effects of ACE inhibition on albuminuria and possibly on renal function.

REVIEW

Although ACE inhibitors have been clearly shown to reduce urinary albumin excretion in diabetic patients, the issue as to whether they confer a specific benefit over other classes of antihypertensive agents remains controversial. Several meta-analyses have suggested that ACE inhibitors are more potent at decreasing albuminuria or proteinuria than other antihypertensive agents, for a given reduction in blood pressure. The Melbourne Diabetic Nephropathy Study Group has instituted a study which is placebo-controlled and is confined to normotensive type I and type II diabetic patients. The ACE inhibitor perindopril has been compared not only with placebo but also with the dihydropyridine calcium channel blocker, nifedipine. Preliminary analysis reveals that after 12 and 24 months of treatment, perindopril is more effective in reducing albuminuria than placebo or nifedipine.

CONCLUSION

ACE inhibitors are a promising class of antihypertensive agents in diabetic patients with microalbuminuria. These drugs should be considered as first line agents in such patients, even in the absence of systemic hypertension.

Authors+Show Affiliations

Department of Medicine, University of Melbourne, Austin, Australia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

9023709

Citation

Cooper, M E.. "Renal Protection and Angiotensin Converting Enzyme Inhibition in Microalbuminuric Type I and Type II Diabetic Patients." Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, vol. 14, no. 6, 1996, pp. S11-4.
Cooper ME. Renal protection and angiotensin converting enzyme inhibition in microalbuminuric type I and type II diabetic patients. J Hypertens Suppl. 1996;14(6):S11-4.
Cooper, M. E. (1996). Renal protection and angiotensin converting enzyme inhibition in microalbuminuric type I and type II diabetic patients. Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, 14(6), pp. S11-4.
Cooper ME. Renal Protection and Angiotensin Converting Enzyme Inhibition in Microalbuminuric Type I and Type II Diabetic Patients. J Hypertens Suppl. 1996;14(6):S11-4. PubMed PMID: 9023709.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal protection and angiotensin converting enzyme inhibition in microalbuminuric type I and type II diabetic patients. A1 - Cooper,M E, PY - 1996/12/1/pubmed PY - 1996/12/1/medline PY - 1996/12/1/entrez SP - S11 EP - 4 JF - Journal of hypertension. Supplement : official journal of the International Society of Hypertension JO - J Hypertens Suppl VL - 14 IS - 6 N2 - BACKGROUND: Many studies have emphasized the role of antihypertensive drugs and in particular angiotension converting enzyme (ACE) inhibitors in the retardation of diabetic nephropathy. Although these studies have focused predominantly on patients with overt proteinuria, more recently a number of investigators have explored the role of ACE inhibitors in both type I and type II diabetic patients with an earlier phase of diabetic renal disease known as microalbuminuria. These agents are now being considered as renoprotective agents not only in hypertensive patients but also in those with 'normal' blood pressure. Initially, studies in type I diabetic patients showed that ACE inhibition was effective in retarding the increase in albuminuria which was observed in placebo treated groups. More recently, several multi-centre placebo controlled studies have been performed suggesting that prolonged treatment not only reduced albuminuria but also preserved renal function. The role of ACE inhibition in microalbuminuric type II diabetic patients is less well characterised although several studies have recently described beneficial effects of ACE inhibition on albuminuria and possibly on renal function. REVIEW: Although ACE inhibitors have been clearly shown to reduce urinary albumin excretion in diabetic patients, the issue as to whether they confer a specific benefit over other classes of antihypertensive agents remains controversial. Several meta-analyses have suggested that ACE inhibitors are more potent at decreasing albuminuria or proteinuria than other antihypertensive agents, for a given reduction in blood pressure. The Melbourne Diabetic Nephropathy Study Group has instituted a study which is placebo-controlled and is confined to normotensive type I and type II diabetic patients. The ACE inhibitor perindopril has been compared not only with placebo but also with the dihydropyridine calcium channel blocker, nifedipine. Preliminary analysis reveals that after 12 and 24 months of treatment, perindopril is more effective in reducing albuminuria than placebo or nifedipine. CONCLUSION: ACE inhibitors are a promising class of antihypertensive agents in diabetic patients with microalbuminuria. These drugs should be considered as first line agents in such patients, even in the absence of systemic hypertension. SN - 0952-1178 UR - https://www.unboundmedicine.com/medline/citation/9023709/Renal_protection_and_angiotensin_converting_enzyme_inhibition_in_microalbuminuric_type_I_and_type_II_diabetic_patients_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=9023709.ui DB - PRIME DP - Unbound Medicine ER -